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Volume 17, Number 8–August 2011
Pandemic (H1N1) 2009–associated Deaths Detected by Unexplained Death and Medical Examiner Surveillance
Author affiliations: Minnesota Department of Health, St. Paul, Minnesota, USA (C.H. Lees, J. Rainbow, R. Danila, K. Nagle, R. Lynfield); New Mexico Department of Health, Santa Fe, New Mexico, USA (C. Avery, C. Smelser); Oregon Public Health Department, Portland, Oregon, USA (R. Asherin, S. Ladd-Wilson); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. Schmitz); and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA (K.B. Nolte)
Suggested citation for this article
During the pandemic (H1N1) 2009 outbreak, Minnesota, New Mexico, and Oregon used several surveillance methods to detect associated deaths. Surveillance using unexplained death and medical examiner data allowed for detection of 34 (18%) pandemic (H1N1) 2009–associated deaths that were not detected by hospital-based surveillance.
The emergence of pandemic (H1N1) 2009 influenza illustrated the need for improved surveillance to identify deaths resulting from emerging pathogens. Common methods for identifying infectious cause–related deaths include reports by health care providers and review of death certificates. These methods have limitations for identifying deaths caused by emerging pathogens because the disease may not be fully defined or death certificates may not indicate an infectious cause. During an emerging pathogen epidemic, it is important to investigate deaths occurring outside of traditional settings to determine if sudden deaths occurring in the community are a result of the novel pathogen.
In 1995, the Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP) Unexplained Deaths Program (UNEX) began in 4 states (1). Under UNEX, deaths likely resulting from an infection, but for which routine testing did not identify a pathogen, are investigated. State and CDC Infectious Diseases Pathology Branch researchers partner with medical examiners and hospital pathologists to review cases and autopsy reports. Expanded resources for specimen testing are provided, which increases the likelihood of a pathogen-specific diagnosis.
The Medical Examiner Infectious Disease Death Surveillance Program (Med-X) was developed in 1999 by the New Mexico Office of the Medical Investigator, New Mexico Department of Health, and Infectious Diseases Pathology Branch to review deaths for infectious causes on the basis of preestablished sets of symptoms and pathologic syndromes (2,3). If there is evidence of an infectious process, specimens are tested to achieve an organism-specific diagnosis. Both UNEX and Med-X have been shown to be useful for bioterrorism and infectious death surveillance (4–6).
The EIP has also established population-based active surveillance for all laboratory-confirmed influenza-related hospitalizations and deaths. Minnesota, New Mexico, and Oregon participate in the UNEX, Med-X, and EIP Influenza Surveillance programs to identify all potential influenza-associated deaths.
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Suggested Citation for this Article
Lees CH, Avery C, Asherin R, Rainbow J, Danila R, Smelser C, et al. Pandemic (H1N1) 2009–associated deaths detected through the unexplained deaths and medical examiner surveillance programs. Emerg Infect Dis [serial on the Internet]. 2011 Aug [date cited]. http://www.cdc.gov/EID/content/17/8/101914.htm
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Christine H. Lees, Minnesota Department of Health, 625 Robert St N., St. Paul, MN 55164, USA; email: firstname.lastname@example.org